Effects of a nurse‐led acupressure programme for stroke patients in China

Aim and objective. To examine the effects of a nurse‐led acupressure programme on the recovery of motor function and daily activities of stroke patients. Background. Stroke is one of the main causes of death and permanent physical disability in the world. The traditional Chinese medicine (TCM) is widely used for the treatment and rehabilitation of people with stroke in China. Physiotherapy or occupational therapy cannot be performed several times a day. Therefore, researchers and healthcare providers have been seeking effective and efficient alternative strategies for the rehabilitation of stroke patients. Acupressure, non‐invasive and widely accessible to any healthcare professionals, is one of the promising alternatives. Methods. Seventy‐eight stroke patients were recruited and randomly assigned into an intervention or control group, with 39 patients in each. The intervention group received acupressure plus routine care, while the control group received only routine care only. The acupressure treatment was carried out by nurses. Patient’s activities of daily living (ADL) and motor function from both groups were evaluated at the point of recruitment, and at the end of the first and third month after stroke. Results. The ADL and the Fugl‐Meyer motor scores in the intervention group were significantly higher than those in the control group at the end of the third month (p < 0·05). Conclusion. Nurse‐led acupressure programme had positive effects on the recovery of motor function and daily activities of stroke patients. Our study suggests that nurse‐led acupressure programmes play an important role in the recovery of stroke patients. Relevance to clinical practice. Healthcare providers need to think about alternative care methods including acupressure for the rehabilitation of stroke patients. Acupressure is one of the promising alternatives nursing intervention for stroke patients in practice.     

How nurses’ use of language creates meaning about healthcare users and nursing practice

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.     

A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision

Aim. This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients. Background. Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services. Methods. A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in‐depth semi‐structured interviews were the instruments used to collect data. Findings. Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service‐related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities. Conclusion. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi‐professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals. Relevance to clinical practice. The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.     

脑卒中康复护理实施现状及其影响因素的调查分析

目的调查脑卒中康复护理实施现状及其影响因素。方法自行设计脑卒中康复护理现状调查问卷,对813名护士进行问卷调查。结果 813名调查对象中对自己所分管的每例患者均实施康复的占38.38%;Logistic回归分析显示,学历、缺乏相关专业知识与技能、护士是否有必要实施康复护理,患者或家属认为不需要、患者或家属主动配合意识差、医院等级、工作繁忙、缺乏康复指引、效果评价及康复护理路径10个因素是护士实施康复护理的影响因素(P0.01或P0.05)。结论影响护士康复护理实施的因素是多方面的,应根据影响因素从宏观角度进行把控,采取多维度的干预措施,提高康复护理实施率。     

The nature of nursing care and rehabilitation of female stroke survivors: the perspective of hospital nurses

Aims and objectives. The aim of this study was to explore the nature of nursing care and rehabilitation of female stroke survivors, as described by hospital nurses. The objectives were to uncover how the nurses perceived the care of female stroke survivors and to explore whether, and in what way, the nurses paid attention to the fact that the patients were women. Background. Nursing care is an important aspect of the rehabilitation of stroke survivors. Little attention has been paid to gender differences in the health care system in general and in the nursing profession in particular, although it is reasonable to think that gender issues may have important implications in the rehabilitation process following a stroke. Design. Design was phenomenological with feminist perspective. Methods. The nurses were interviewed in‐depth. In the data analysing process we were inspired by Giorgi's phenomenological method. Results. The nurses were focusing primarily on functional and practical aspects of the women's situation. They perceived the rehabilitation process predominately from a professional rather than the patient point of view, and from a non‐conscious and primarily gender‐neutral perspective. Conclusions. The results indicate that the nurses perceived nursing care primarily in terms of practical actions to promote the body's functional and practical abilities. Little attention was directed to the stroke survivors’ experiences of their life body, nor to the fact that the patients were women. Relevance to clinical practice. In order to promote care from the perspective of the female stroke survivors, we believe it is necessary to attend to the life experiences of the patient, which also mandates paying attention to how gender has an impact on their diseased bodies, every day life, values and preferences in the situation.     

Perceptions and concerns about sustainable healthcare of nursing students trained in sustainability and health: A cohort study

AimTo describe nursing students' perceptions of sustainable health education in the nursing curriculum and their concerns about sustainable healthcare and the impact of climate change on nursing.BackgroundSustainable health education involves education on the impact of climate change on health and the impact of healthcare on the environment. The effectiveness of sustainable health education in improving attitudes, knowledge and skills in sustainable healthcare has been demonstrated. However, there is a need to study students' perceptions of this and their concerns about achieving sustainable healthcare from the use and disposal of healthcare resources.DesignA cohort study with an inductive content analysis of open-ended questions included in a survey.MethodsThe study was carried out with undergraduate nursing students throughout their four-year undergraduate academic program using scenario-based learning and augmented reality related to sustainability, climate change and health. As students were exposed to three educational interventions, they completed a survey of open-ended questions about their perceptions of their environmental sustainability training in the nursing curriculum, their concerns about the resources’ used in healthcare and their perceptions of the impact of climate change on the nursing profession.ResultsStudents identified content in the nursing degree program on climate change and health and hospital waste segregation. They also demanded more content on 'low environmental impact nursing care' when their clinical practice training increased. Students were concerned about the excessive and unnecessary use of materials in healthcare, especially in the post-pandemic period, the lack of environmental awareness of healthcare professionals and the lack of power to change the situation. They recognised the lack of proper waste segregation in healthcare settings, no recycling bins and little reuse of materials. They were also concerned about the polluting disposal of material. They perceived important impacts of climate change on nursing, such as patient care due to increased pollution-related diseases, including foetal malformations and new health care needs arising from weather conditions. Finally, students were concerned about the impact this will have on nursing care work and require 'nursing leadership in environmental awareness'.ConclusionsStudents demand more training in low environmental impact healthcare and innovative educational practices are effective in this regard. Appropriate Sustainable Healthcare Education can make future health professionals more environmentally aware and enable them to lead the shift towards climate-smart care.Tweetable abstractStudents demand more training in low environmental impact healthcare and perceive significant impacts of climate change on nursing.     

Review: the legal duty of care for nurses and other health professionals

Aims and objectives. To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. Background. The paper seeks to re‐frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. Design. Doctrinal legal ‘approach’. Method. ‘Black letter’ legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. Results. There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. Conclusions. A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. Relevance to clinical practice. Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.     

Stroke patients' perceptions of hospital nursing care

? While nursing remains uncertain about the nature of its role in stroke rehabilitation, recent research by social scientists re-affirms its importance. ? This study explored a small number of stroke patients' perceptions of hospital nursing care in order to illuminate the meaning of the role in practice. ? Informants' early experiences of nursing care in general medical and care of the elderly assessment wards were dominated by having the necessary done, while nursing in the Stroke Rehabilitation Unit was characterized by a do it yourself approach. ? These two concepts are explored in detail and related to the existing literature, suggesting some specific areas for practice development and research.     

Nurse‐Managed Free Clinic Fosters Care Connection for Homeless Population

The goal of this article is to demystify the process that healthcare providers must follow when working with homeless patients who sustain injuries or exhibit illnesses that necessitate rehabilitation care. Observations made over a period of more than 12 years at an inner‐city medical/psychiatric nurse‐managed free clinic that delivers cutting‐edge services and educates multidisciplinary students to care for disenfranchised populations led the author to several conclusions: homeless people frequently lose their identity as individuals when facing healthcare providers; previous negative perceptions of homelessness can turn positive when care providers meet these patients on a person‐to‐person level; the concept of health and rehabilitation must be clearly understood in the same way by both providers and patients for nursing goals to be realistic and achievable; and a collaborative relationship must be formed between nurses and patients.     

Therapeutic Music and Nursing in Poststroke Rehabilitation (CE)

Individuals who experience stroke undergo a critical rehabilitation process with the aid of professionals including physical, occupational, and speech therapists, as well as primary care from nursing staff. However, the extent of the role that music can play in facilitating the rehabilitation process is unknown. Board‐certified music therapists are employed in several capacities within the rehabilitation environment. There is a need for nursing professionals in this area to better understand the role a music therapist may play and how they can assist clients in using music in a therapeutically beneficial way. The purpose of this article is to educate nurses about music therapy and provide evidence for the therapeutic use of music in the rehabilitation setting for victims of stroke.     

Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study

Aims and objectives. The aim of this study was to evaluate long‐lasting changes in the nursing staff's understanding of oral health care for cancer patients after an oral health care intervention. The study also assessed whether there were changes between registered nurses and auxiliary nurses. Background. The maintenance of good oral health care in cancer patients is essential for nutrition, recovery and wellbeing and requires the involvement of nursing staff. However, several studies reveal that the need to prioritize oral health care has not been made sufficiently clear. Methods. The nursing staff (registered nurses, n = 133 and auxiliary nurses, n = 109) on five wards at different hospitals providing cancer care took part in a four‐hour oral healthcare training session, including the use of an oral assessment guide and answered a questionnaire initially and after this intervention. The data were statistically analyzed. Results. Several aspects of implementation opportunities improved, but they did not include attitudes to oral health care. Knowledge of oral diseases decreased, more for auxiliary nurses than for registered nurses. Conclusions. A four‐hour oral health training session and subsequent activities improve the nursing staff's understanding of oral health care for patients with cancer diagnoses in some respects but not in terms of attitudes to oral health care or specific oral knowledge. Relevance to clinical practice. Oral healthcare education and training activities for nursing staff can produce some improvements in the understanding of oral health care for cancer patients but not in attitudes and specific oral knowledge. These areas must be covered during the basic education period or/and by a routine oral healthcare programme for nursing staff, probably including an oral healthcare standard.     

Concept analysis: confidence/self-confidence

BACKGROUND. Confidence and self‐confidence are crucial practice elements in nursing education and practice. Nurse educators should have an understanding of the concept of confidence in order to assist in the accomplishment of nursing students and their learning of technical and nontechnical skills. With the aim of facilitating trusted care of patients in the healthcare setting, nursing professionals must exhibit confidence, and, as such, clarification and analysis of its meaning is necessary. PURPOSE. The purpose of this analysis is to provide clarity to the meaning of the concept confidence/self‐confidence, while gaining a more comprehensive understanding of its attributes, antecedents, and consequences. METHOD. Walker and Avant's eight‐step method of concept analysis was utilized for the framework of the analysis process with model, contrary, borderline, and related cases presented along with attributes, antecedents, consequences, and empirical referents identified. CONCLUSION. Understanding both the individualized development of confidence among prelicensure nursing students and the role of the nurse educator in the development of confident nursing practice, nurse educators can assist students in the development of confidence and competency. Future research surrounding the nature and development of confidence/self‐confidence in the prelicensure nursing student experiencing human patient simulation sessions would assist to help educators further promote the development of confidence.     

A Model for Professional Rehabilitation Nursing Practice

As partners in health care, clinical and administrative nurses must share in the work, risks, and rewards inherent in nursing practice while promoting high-quality results in a cost-conscious and cost-effective environment. One way to achieve these results is by developing a nontraditional rehabilitation structure and nursing practice model. This article discusses practical strategies for constructing and implementing such a model; it also identifies tangible outcomes of using the model. The healthcare environment in the 1990s demands a high level of involvement on the part of staff; the rehabilitation nursing model presented in this article meets this challenge.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

How to Choose and Develop Written Educational Materials

Education is a key component of comprehensive rehabilitation care because it helps promote clients' healthy behaviors and recovery from diseases and injuries or adaptation to chronic conditions. Choosing to use written, organization‐based, commercially generated, and Internet‐based educational materials is dependent on credibility, readability, and availability. If these materials are unsuitable or no appropriate information on a topic is available, the decision to adapt existing material or design new materials must be made. Recommendations for developing readable materials center on having a clear purpose for writing about a topic; listening to patients; presenting accurate information that reflects accepted, common practice; and using a clear writing style. The strategies presented in this article are intended to help nurses and other healthcare professionals choose or develop educational materials for patients and their family members.     

Rationale and principles of early rehabilitation care after an acute injury or illness

Patients hospitalized for an acute illness or injury are at risk of experiencing a significant loss of functioning as defined by the International Classification of Functioning, Disability and Health (ICF). The risk of a significant loss of functioning is increased in critically ill patients, in patients with complications or long-term intensive care stays, in persons with disabilities or with pre-existing chronic conditions and in the elderly. Early identification of rehabilitation needs and early start of rehabilitation can reduce healthcare costs by reducing dependence and nursing care, length of stay and prevention of disability. Two principles of rehabilitation for acute and early post-acute care can be distinguished. First, the provision of rehabilitation by health professionals who are generally not specialized in rehabilitation in the acute hospital. And second, specialized rehabilitation care provided by an interdisciplinary team. There is large variation how this specialized, typically post-acute rehabilitation care is organized, provided, and reimbursed in different countries, regions, and settings. For instance, it may be provided either in the acute hospital or in a rehabilitation or nursing setting. Most in-patients do not receive specialized rehabilitation at all during their whole stay in the acute hospital. But, it is important to point out that health professionals working in acute hospitals and who are not specialized in rehabilitation need to be able to recognize patients' needs for rehabilitation care and to perform rehabilitation interventions themselves or to assign patients to appropriate rehabilitation care settings. The principles outlined in this paper can serve as a basis for the development of clinical assessment instruments to describe and classify functioning, health and disability of patients receiving acute or early post-acute rehabilitation care.